Can Lo Loestrin Fe (ethinyl estradiol and norethindrone) be taken with Cymbalta (duloxetine) and Amitriptyline?

Lo Loestrin Fe Can Be Taken with Cymbalta and Amitriptyline

Lo Loestrin Fe (ethinyl estradiol and norethindrone) can be safely taken with Cymbalta (duloxetine) and amitriptyline as there are no significant drug interactions that would affect contraceptive efficacy or increase risks of adverse effects. Based on the available evidence, these medications do not have clinically significant pharmacokinetic interactions that would contraindicate their combined use.

Drug Interaction Analysis

Hormonal Contraceptives and Antidepressants

• Lo Loestrin Fe contains ethinyl estradiol (EE) and norethindrone (NET), which are metabolized primarily through the CYP450 enzyme system
• According to the U.S. Medical Eligibility Criteria for Contraceptive Use, antidepressants like Cymbalta (duloxetine) and amitriptyline are not listed among medications that significantly interact with combined hormonal contraceptives 1
• The guidelines specifically identify medications that reduce contraceptive effectiveness, such as certain anticonvulsants, rifampicin, and some antiretrovirals, but do not include SNRIs or tricyclic antidepressants in this category

Specific Medication Considerations

Cymbalta (Duloxetine)

• Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that may interact with drugs metabolized by CYP1A2 and CYP2D6 1
• However, there is no evidence that duloxetine significantly affects the metabolism of ethinyl estradiol or norethindrone
• Compared to other antidepressants, SNRIs like duloxetine have relatively fewer effects on the CYP450 system that would impact hormonal contraceptives

Amitriptyline

• Amitriptyline is a tricyclic antidepressant that is not listed among medications that interact with combined hormonal contraceptives in the medical eligibility criteria 1
• While research on specific interactions between amitriptyline and hormonal contraceptives is limited, studies examining the combination of amitriptyline with other psychotropic medications have not shown clinically significant pharmacokinetic interactions that would affect contraceptive efficacy 2

Clinical Considerations

Contraceptive Efficacy

• Lo Loestrin Fe contains a low dose of ethinyl estradiol (10 μg) and norethindrone (1 mg)
• The efficacy of Lo Loestrin Fe should not be compromised when taken with Cymbalta or amitriptyline, as these medications are not known enzyme inducers that would reduce contraceptive hormone levels 1

Potential Side Effects to Monitor

• When using these medications together, be aware of potential overlapping side effects:
  • Nausea, dizziness, and headache (common with all three medications)
  • Dry mouth (common with both antidepressants)
  • Changes in blood pressure (monitor if taking all three medications)

Special Considerations for Duloxetine

• Duloxetine may cause hepatic effects in rare cases 1
• Monitor for signs of liver dysfunction such as jaundice, abdominal pain, or elevated liver enzymes
• If signs of liver dysfunction occur, discontinuation of duloxetine should be considered

Practical Recommendations

1. Take Lo Loestrin Fe as directed, at the same time each day to maintain contraceptive efficacy
2. No additional contraceptive methods are required when using these medications together
3. Monitor for common side effects that may be additive when using multiple medications
4. Regular follow-up appointments are recommended to assess tolerability and effectiveness

Conclusion

Based on the current medical evidence, Lo Loestrin Fe can be safely taken with Cymbalta and amitriptyline without concerns about reduced contraceptive efficacy or significant adverse drug interactions. Unlike certain anticonvulsants, rifampicin, or some antiretrovirals that are known to reduce hormonal contraceptive effectiveness, these antidepressants do not appear to have clinically significant interactions with combined hormonal contraceptives.